Jonathan Phen

NPI #1093400160 in East Peoria, Illinois

Provider Information

NPI Number: 1093400160
Entity Type: Individual
Name: Jonathan Phen
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Enumeration Date: Apr 5, 2023
Last Updated: Apr 10, 2023

Practice Location

Address: 502 RIVERSIDE DR
City: East Peoria
State: Illinois
ZIP Code: 61611-2068
Phone: (309) 606-5008

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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